Efficacy of Art Therapy in Treating Patients with Paranoid Schizophrenia

Paranoid Schizophrenia chronic mental illnesses according to DSM-IVTR characterized by the presence of delusion of persecution, suspicious, distrusting, guarded, reserved, tensed, and also sometimes hostile or aggressive. Patients also perceive exaggerated warmth and friendship by the professionals as attempt at bribery, manipulation or exploitation. But therapeutic relationship between patient and the professional is integral to the recovery process and the outcome. Good communication on the part of health care professionals is an essential element in developing the strong practitioner-patient relationship necessary in the treatment of schizophrenia. Professionals are usually at a look out for tools to build a working alliance best used in such cases. Usually behavioural therapy, supportive therapy and family therapy are used for such patients. But sometimes with chronic and resistant client will get stuck at the initial rapport itself. At this stage probably art therapy as an advance intervention strategy to work with patient as an advanced intervention strategies and treatment.

Cognitive Remediation Therapy in Chronic Schizophrenia

Cognitive impairments are now recognized as one of the most ubiquitous features of schizophrenia. Cognitive deficits appear to play a large role in how patients with schizophrenia function in their everyday lives. The role of cognitive deficits in schizophrenia may be gauged by the fact that even when patients with schizophrenia are relatively free of psychotic symptoms, many still have extraordinary difficulty with communication, motivation, self-care, and establishing and maintaining relationships with others. Patients with schizophrenia are often additionally treated with supportive psychotherapy, behavioral management, or social skills training as required. However, the efficacy of these adjunct therapies could be limited in presence of marked cognitive deficits. Thus it becomes crucial to have specific intervention for the underlying cognitive deficits that appear detrimental to improvement of functioning of patients with schizophrenia. The present chapter focuses on cognitive training based intervention program for schizophrenia patients and its efficacy.

Chronic Mental Illness in Prisons

It has been known that psychiatric disorders are highly prevalent among prisoners. Many people with identifiable psychiatric illness do conflict with the law, often by no fault of their own but because of symptoms of their psychiatric illness and end up in jails. Poor communication between the prison, court, and hospital systems hinders the assessment and management of the mentally disordered offender, and medical intervention can actually delay release from custody. In conclusion Prisons are detrimental to mental-health, and the standards of psychiatric care are significantly lower than those for the general public. Certain remedial measures are to be implemented for a better future of prison and community because ultimately these prisoners will be released from prison and become a part of community. Beginning of reforms is the immediate need as a long journey ahead.

Comorbidity Issues and Treatment in Chronic Mental Illness

Comorbidity refers to presence of one or more additional disorders along with a primary disorder. It affects the prognosis and course of treatment. It is often difficult for clinician to make correct diagnosis in presence of various disorders. The clinical picture of various disorders interferes with treatment process and the outcome. There are some disorders in psychiatry, known as chronic illness. These are schizophrenia, bipolar disorder and obsessive-compulsive disorder. All these three disorder have a major effect on individual's life. Anxiety, depression, substance abuse and panic symptoms are common in schizophrenia; hence the clinical picture changes frequently. While the literature suggests that presence of two or three disorders make treatment worse, hence multidisciplinary treatment need to be used.

Chronic Mental Illnesses and Homelessness

Homelessness is a complex socio-economic problem complicated by individual attributes and risk factors. The burning issue of homelessness has been a subject of concern in the modern day world often stretching the existing administrative system to innovate and design models for managing the same. With the changing definitions of homelessness, the estimates have also varied across cultures and countries. Because of the inherent difficulty in studying homelessness, accurate estimates of the number of homeless are lacking. Most studies in the West report that approximately 288 per 10,000 people are homeless. With the accurate data on homelessness lacking, the estimates of mental illness amongst homeless is even more obscure. The prevalence of mental illness amongst homeless is higher than that compared to the general population. Researchers have theorized various stressors related to homelessness as precipitating factors of mental illness. There is dearth of literature on mental illness in homeless population which is representative of the homeless population at a national level.

Psychosocial Intervention Studies for Street Children with Substance Abuse

The chapter made an attempt to review the literature and describes various interventions available for street children. The current chapter enlists all the intervention activities carried out for this group. Method of the study followed web based literature review (secondary data) using pubmed, Ebsco, Psyinfo, like on by using key words such as street children, substance abuse, motivation, intervention like on. Totally about 300 studies had been found out which discussed about street children. Among them the reviewers had chosen important studies for review purpose. Studies were discussed under the subthemes of concept of street children, prevalence of street children, reasons for on the street, street life and ways of coping with stress, substance abuse among street children, intervention carried out with street children and substance abuse, suggestions and conclusion. Conclusion: The discussed psychosocial intervention in the chapter are well proven in the general population and effectively tried with street children.

Legal Aspects of Chronic Mental Illness

People with a chronic mental illness or disability have been identified as a group suffering multiple disadvantages. Law interacts with mental disorder to protect society from the dangerous consequences of mental disorder. The legal interaction with mental disorder includes both civil and criminal issues. A paradigm shift has given a new perspective to the care of mental disorders and has led to the review of mental health legislations worldwide in general, India in particular. This chapter will discuss the interaction of law and psychiatry, rights of persons with mental disorder and the gap in implementation of these laws.

Global Burden of Mental Disorders

Mental disorders are an important cause of long-term disability and dependency. It accounts for over 15% of the disease burden in developed countries, which is more than the disease burden caused by all cancers. Mental illness is a leading cause of suffering, economic loss and social problems. The burden of mental disorders is likely to have been underestimated because of inadequate appreciation of the connectedness between mental illness and other health conditions. Mental disorders increase risk for communicable and non-communicable diseases, and contribute to unintentional and intentional injury, and comorbidity complicates help-seeking, diagnosis, and treatment, and influences prognosis. Consequently, health professionals have trivialized the issue of mental illness. It is essential that researchers and public health professionals work together to resolve the enormous public health crisis presented by mental disorders. In short, we must “mainstream” mental health.

Chronic Mental Illness and Dumping Patients

Patients with mental illness don't take care of themselves, are dependent not only for medicine intake but also for their day to day requirements including their personal hygiene. All these issues and many more put a heavy psychological burden on the families. When they become overburdened with these responsibilities and problems they find it easy to dump patients in the mental institutes. There are very few mental health institutes in India but the number of patients with chronic mental illness is very high. The common problems are poor social environment, hostile family environment, unaffordable prices of medicines Few efforts like proper psycho-education, frequent phonic follow-ups from the professionals, proper guidance, family therapy, supportive psychotherapy etc. can be done. The government should also take some steps to manage the chronically ill patients like following strict rules to avoid dumping patients in the mental health institutes. Proper vocational training and job perspective should be planned for these populations so that they can be less dependent on their families.

Disability in Schizophrenia

Schizophrenia is considered to be the paradigmatic illness of psychiatry. The illness is characterized by marked disturbances and abnormalities in the domains of thought, perception, speech, emotion and behavior. The expression of the symptoms varies across patients and over time, but the cumulative effect of the illness is always severe and usually long lasting. Schizophrenia often takes a chronic course and patients exhibit difficulty re-attaining their optimum level even after resolution of clinical symptoms. Disability though is associated with many illnesses, with arguably the disability associated with chronic mental illness and schizophrenia in particular is more difficult to cope up with due to the associated stigma and care burden. The chapter focuses on different aspects of disability in schizophrenia with specific emphasis on neurocognitive and psychosocial functioning and their correlation in schizophrenia, with support from research by the author and relevant literature.